Effects of Different Timing of Alveolar Bone Graft on Craniofacial Morphology in Unilateral Cleft Lip and Palate.

OBJECTIVE: To evaluate the effect of the timing of secondary alveolar bone graft (SABG) on craniofacial morphology in patients with complete unilateral cleft lip and palate (UCLP). DESIGN: Single-center retrospective assessment of consecutively treated nonsyndromic patients with complete UCLP. PARTICIPANTS: One hundred sixty-seven patients (108 males, 59 females) with complete UCLP in whom the cleft was repaired with 1-stage method at approximately 8 months of age. The age of 128 patients at SABG varied from 1.4 to 11.5 years (SABG group), while 39 patients still awaited SABG at the moment of cephalometric evaluation (no-SABG group). METHODS: Craniofacial morphology was assessed on lateral cephalograms taken at 10 years of age (standard deviation = 0.8; range: 7.5-12.3) using linear and angular measurements. T tests and regression models were made to analyze data. RESULTS: Regression models demonstrated that the effect of SABG on the craniofacial morphology was limited-cephalometric variables which were statistically significantly different between SABG and no-SABG groups showed no association with the timing of SABG when (1) age of primary repair of the cleft, (2) age of cephalometric evaluation, (3) cleft side, (4) gender, and (5) operator were controlled for. Only the length of the maxilla (Condylion-point A) was affected-1-year delay of SABG corresponded with an increase in Co-point A distance by 0.52 mm. However, adjusted R2 of the model was 0.11. CONCLUSIONS: Our findings cautiously indicate that SABG performed before 8 years of age can have limited negative effect on craniofacial morphology. Nevertheless, our results should be confirmed by cleft centers practicing alternative surgical repairs of the cleft.

Cephalometric comparison of early and late secondary bone grafting in the treatment of patients suffering from unilateral cleft lip and palate.

The study was based on a retrospective cephalometric assessment of 10-year-olds in order to evaluate the influence of early secondary bone grafting on craniofacial development in patients suffering from non-syndromic complete unilateral cleft lip and palate. The study consisted of 79 patients in the early and 67 patients in the late secondary bone grafting group. The mean age at alveolar bone grafting was 2.5 years (SD 0.03) in the first group and 9.8 years (SD 2.3) in the second group. The primary cleft repair of these 146 patients was always performed in accordance with the one-stage method. Additionally, the non-cleft Control group was comprised of 56 children of the same ethnicity and age. The cephalometric analysis performed at age 10 revealed similar overall characteristics of observed growth disturbances in both cleft groups in comparison to the Control group, such as: inhibition of vertical and anterior maxillary development, the tendency of the mandible to rotate clockwise, and a prevalence of vertical over horizontal facial growth. The comparison between the cleft groups revealed a lack of growth differences in the vertical dimension and more pronounced anterior maxillary development inhibition in the early bone grafting group. This study will be followed by a similar evaluation after craniofacial development is complete by a significant number of these patients in order to ascertain our conclusions.

Outcome of alveolar bone grafting in patients with unilateral cleft lip and palate operated by one-stage method.

UNLABELLED: The aim of the study was the assessment of outcome of alveolar bone grafting in patients with unilateral cleft lip and palate operated on by the one-stage surgical procedure. MATERIAL AND METHODS: The study concerned 108 patients (69 boys, 39 girls) with unilateral cleft of lip and palate operated by one stage method in the Surgical Department of Children and Adolescents IMC between 1994 and 2003. The reconstruction of alveolar process in these patients was carried out by autogenic bone graft at the age ranged from 1.5 to 16 years. The surgical procedure was the same regardless of age. The patients were divided into 3 groups according to age during this procedure: I- below 6 years, II - between 6 and 10 years, III - above 10 years. Evaluation of outcome of bone grafting was assessed on the base of Oslo classification and Chelsea scale. The relation between the patient's age at the time of bone grafting and the bone healing result was analyzed by the Spearman's rank correlation coefficient for the studied group as a whole, the age subgroups and the gender groups. RESULTS: Good results of treatment (I and II type) was obtained in 93 (86%) of patients, bad (III and IV type) in 15 patients according to Olso classification. According to Chelsea scale ultimate or satisfactory results (A, B, C) were obtained in 93 patients (86%) , unsatisfactory results (D, E, F) were obtained in 15 patients. Negative correlation between bone graft outcome and age of patients at the time of the procedure above 6 years was confirmed. No statistical significance in relation to sex of patients was found. CONCLUSIONS: According to two classifications (Oslo, Chelsea) good results of bone graft were obtained in 86% of patients. There was a relationship in outcome of bone grafting and the age of patients. The inter-gender correlation did not gain the statistical relevance.